Nitrosol 400mcg Nitroglycerin Aerosol Spray

✔️ Dosage

At the beginning of an angina attack, apply 1 or 2 sprays under the tongue. Do not exceed 3 sprays within a 15-minute window. If chest pain continues, seek immediate medical help. For prevention, use the spray 5 to 10 minutes before physical or emotional stress that may provoke an attack. Safety and efficacy in children have not been established.

✔️ Overdose Effects

Symptoms of overdose include severe low blood pressure, persistent headaches, dizziness, palpitations, vision problems, nausea, vomiting (potentially with blood), fainting, bluish skin, breathing difficulties, slow heart rate, confusion, coma, seizures, and death due to circulatory collapse.

Methemoglobinemia: Although rare with standard doses, high doses or genetic predisposition may increase risk.

Treatment:

• Lay the patient down with legs elevated.
• Keep the person warm and encourage gentle limb movement.
• Administer oxygen and artificial ventilation if needed.
• If methemoglobinemia occurs, administer IV methylene blue (1-2 mg/kg).
• Gastric lavage may help if a large amount was swallowed recently.

✔️ Side Effects

Potential side effects include headache, facial flushing, dizziness, nausea, vomiting, weakness, low blood pressure when standing (postural hypotension), and rapid heartbeat (reflex tachycardia).

✔️ Important Instructions:

• Angina patients should always carry Nitrosol spray. Keep an additional supply easily accessible, such as on a bedside table.
• This spray is not for daily routine use—only apply when symptoms start.
• Avoid alcohol consumption after using this medication.
• Do not use medications for erectile dysfunction (e.g., sildenafil, tadalafil, vardenafil) while taking nitroglycerin. This combination can lead to a dangerous drop in blood pressure, unconsciousness, heart attack, or death.
• Keep away from children's reach.

✔️ How to Use the Spray:

• Sit down immediately when angina begins.
• Remove the cap—do not shake the container.
• Hold upright with the forefinger on the button.
• Open your mouth, place the nozzle near, and aim under the tongue.
• Press the button slowly to spray under the tongue.
• Release the button and close your mouth—avoid swallowing right after use.
• Do not drink water for 5–10 minutes after use.
• If a second dose is needed, repeat steps 3 to 6. Replace the cap afterward.
  Take this medication only as directed by a registered physician.

✔️ Drug Interactions

Combining Nitrosol with alcohol can lead to significant low blood pressure and collapse. It may also increase the effects of dihydroergotamine. Using it alongside calcium channel blockers, phenothiazines, or tricyclic antidepressants may increase the risk of orthostatic hypotension.

✔️ Contraindications

Do not use in cases of known allergy to nitrates, low blood pressure, low blood volume, severe anemia, head trauma, cerebral bleeding, mitral valve narrowing, or angina due to hypertrophic obstructive cardiomyopathy. Avoid using with phosphodiesterase inhibitors for erectile dysfunction.

✔️ Use in Pregnancy & Lactation

Category C. There are no adequate studies in pregnant women. Nitroglycerin should be used during pregnancy only if clearly necessary. It is unknown whether it passes into breast milk, so caution is advised during lactation.

✔️ Precautions & Warnings

In early stages of a heart attack, careful monitoring of blood pressure and heart function is necessary when using Nitrosol. Use with caution in patients with severe liver or kidney dysfunction, thyroid disorders, poor nutrition, or low body temperature.

✔️ Storage:

Store in a cool, dry place away from light and heat. Keep out of reach of children.